Update February 2019 (Loose incisor)

Wow!  It's been a long time since I've posted something new on my blog.  So I guess it's time.

So last year, I think in October, another one of my beautiful crowns detached.  I hate that!  It feels like parts of my body are dropping off. Not a good feeling.

This was the lateral upper-left incisor.  It had never given me problems before, and I was chagrinned that it might be following in the path of its neighbor, which fell off so often that it needed a root canal (in 2015).  It fell off while eating. A little too much lateral strain, I guess.

Not a welcome development, but it's how it goes when you have 28 crowns.

The other change that I've made to this site was to try to remove my posts about the old Topix forums, which discontinued service after many years.  If you happen to stumble upon dead links, I'd appreciate it if you'd email me so I can brush them up.  Thanks.

Tags:

Update February 2019 (Loose incisor)

By CometGlare → Monday, February 18, 2019

Excellent Report on Dr. Flikier and Dr. Grunhaus

Here's a story about the One that Got Away.

People sometimes contact me for help, and I try to steer them to dentists appropriate for their needs and pocketbook.  In the Summer of 2016, a lady from Boston contacted me asking me to recommend a dentist in CR for her full-mouth restoration.  We talked over the phone about the various dental clinics, and of course I recommended a fact-finding trip to CR, if practical.  This is the ideal approach, assuming sufficient time and money.  She seemed quite receptive to that suggestion, and we ended the conversation with me thinking that my next contact from her would be from Costa Rica.  So, lo and behold, a week later she contacted me again, saying that she had the most wonderful visit with Dr. Flikier and his periodontist, Dr. Grunhaus.  I thought this was a remarkable display of energy: to plan and execute a visit to Costa Rica within a few days of hatching the idea!

Well, it turns out that it was even better than that.  The word that comes to mind is "serendipity":  She had contacted a couple of dentists by email and discovered that one of her top choices would be visiting Boston later that week for a dental conference.  She made arrangements to meet him and his periodontist in Boston one day after the conference.  So instead of flying to San Jose, she just took a short trip in the city.  And had a great visit with them, in a coffee shop, I think.

Her dental work turns out to be very similar to my own:  A lot of gum lengthenings and crowns.  She had the gum work done in September 2016, and went back in November for the crowns.  She sent me this glowing report upon completing her dental work:

Dr. Flikier is wonderful and so thorough and professional.  His colleague who is the gum surgeon, Dr. Grunhaus did a fantastic job in September.  No need for any touch up on the gums at all.  They matched perfectly with the teeth.  Lorenzo is amazing also. [Lorenzo Favini heads the dental lab which also did my superb crowns. -dave]  A true artist at making the teeth.

I get my final teeth on Friday.  Everything has gone unbelievably smoothly.  Definitely recommend Dr. Flikier to people.  He is really top notch!!

My living situation has been great too.  Less than two blocks from his office.  In fact, he's coming over next week to see it so he can recommend it for future patients.

So, in short, a good time was had by all. 

Oh, yeah.  So what got away?  

Well, I'd love to post pics on my blog so I had asked her to provide before and after photos of the work.  Easier said than done.  There are a million things to do for major dental work, and sometimes helping some guy you met on Internet liven up his blog isn't one of them.  So that fell through, leaving me with no pics but with a funny story with a happy ending instead.  Almost as good.

Tags: DrFlikier → DrGrunhaus

By CometGlare → Monday, May 28, 2018

Update May 2018

Update May 2018

It's been a while since I've posted, but don't worry.  That's mainly because not much has been happening.  So it won't take long to brief you.

My crowns are holding up well.  After local dentist retired, his replacement did notice a slight chip on one of the premolars.  It's visible only under clinical inspection, but the mere thought of it means that I'm aware of it.

I mentioned that my nightguard was bringing bacteria into my mouth, and that I had to change the way I was storing it.  I had been putting it into plain water, but this turns out to be bad, bad, bad.  The water became a breeding ground for bacteria, which wouldcome into my mouth every night when I put on the night guard.  Now I keep the water bug-free by adding some chlorhexadine, a prescription antiseptic and mouthwash, and changing the water every week.  I rinse off the nightguard before putting it in my mouth.  Who would think that this small a change could so improve the way my gums feel?  And they felt okay to begin with....

Here's an odd event that probably doesn't happen to everyone with dental work done in Costa Rica...My former, now-retired dentist called me out of the blue one day a few months back, asking for the name of my Costa Rica dentist.  One of his former patients or friends wanted to know.  That's a great testimonial to quality, from both the dentist and the dental lab.  My current dentist has also praised my dental work.

So that's about all the non-news that I have.

More later, or when there are new developments to report.

Bye.

Tags:

Update May 2018

By CometGlare →

Nothing much is happening with me, but CR dental tourism is still doing well

Welcome, stalwart readers!

I just answered answered a comment from a reader bemoaning the lack of activity on the Topix dental forum and this blog.  It's true that things seem to have slowed down, but that is partly because dental tourism in CR is becoming more routine and less remarkable (or re-post-able).  Dental tourists who do their homework on the Topix and TripAdvisor forums (and hopefully this little blog) can expect good results.  Finding a great dentist in CR is becoming less an art and more a science.

As for me, things are pretty much unchanged dentally, and so I haven't seen any excuse to post.

I did get some facial plastic surgery a couple months back, and my cheek became infected. (An incision was made inside my mouth during the procedure.)  I wear a night guard at night, and I suspect that I wasn't keeping it germ-free, laying in water all day long.  That's about as close to a dental happening as I can come up with.

(In case you're wondering, I had the surgery done here in the States.)

Thanks for checking in!

Tags: AboutMe

Nothing much is happening with me, but CR dental tourism is still doing well

By CometGlare → Sunday, February 26, 2017

Interview with Dr. Mariano Kriebel of Kriebel Dental

Interview with Dr. Mariano Kriebel of Kriebel Dental 

 kriebeldental.com

Here's an interview--conducted via the magic of email--with an excellent Costa Rican specialist dentist, Dr. Mariano Kriebel, about his great specialist clinic, Kriebel Dental.  Readers of this blog know how much I like specialists, especially those trained in the U.S., such as Dr. Mariano Kriebel and his father, Dr. Ricardo Kriebel, and their associates.

Here's how this interview happened.  A few weeks ago, I posted a favorable review by a patient of this clinic. (To find that post, click on the "DrKriebel" label.)  Dr. Kriebel saw it and sent me a thank you note, suggesting that I put up some testimonials from his web site.  This I couldn't do, though I'm happy to put up testimonials that I receive directly from patients.  Instead, I suggested that we conduct a little interview.

Disclaimer:  I have no business or financial interest in this clinic (or indeed any of the other clinics mentioned on this blog).  Even though I have not met any of the dentists at Kriebel Dental, I feel confident in recommending this clinic because of the previous patient's excellent report and the specialty training of the principal clinic dentists.

I have not edited Dr. Kriebel's responses except to improve on spelling in a couple of places. 

Question 1: You are a father-and-son team of prosthodontists, trained in the US.  Does dentistry run in your family?  

Answer: Kriebel Dental means four generations of dentists serving national and

international patients for over 100 years. The clinic was founded by Dr. Ricardo

Kriebel Staats, who arrived from Dusseldorf, Germany, in 1894. My grandfather,

Dr. Kriebel Rodriguez, an Honorary Member of the American Dental Association

among many distinctions, retired from the practice of dentistry in 2008, after 66

continuous years of treating patients.

My father Dr. Ricardo Kriebel Coronado, trained as a specialist in Prosthodontics

from Indiana University, joined the practice in 1981 and is currently working

with me. I joined the practice in 2012 after graduating as a Prosthodontist from

The Ohio State University. I also served as a clinical instructor in The Ohio State

College of Dentistry for 4 years.

Question 2:  You have an interesting CV, Dr. Kriebel.  You are the first prosthodontist I know of who can boast of specialty training in implantology too.  What is your role in the clinic, which also has another implantologist, and an endodontist, and your father, the prosthodontist?

Answer: I have a specialty in Prosthodontics and also have advanced training in

implant dentistry in both the surgical and restorative aspects. I spent one extra

year at The Ohio State University only working with implant patients. We

managed to restore over 1000 implants between the 3 resident doctors. In the

clinic I work as a full time prosthodontist as well as my dad. I do implant

placement surgery and we have an oral surgeon who supports the clinic in

specific cases, example: third molar extractions, block grafts and pathology. We

have an endodontist, Dra. Perez, she graduated from Baylor College in Texas. She

is a great professional and her expertise are very hard to beat.

Question 3:  There's always discussion about which dental implants are the best.  I imagine that questions like this are best decided with the patient in front of you, but could you give us some general advice about implant brands that might be useful to many US patients thinking of getting implants?

Answer: Currently here in Costa Rica we have a wide variety of options regarding

dental implant selection. The majority of implant brands are very good and I

personally feel they all work very well. It all comes down to the personal choice

of the dentist, the most important aspect is to find a dentist with the right

training and knowledge in order to use them correctly. Some of the implants I

like to use are: Zimmer and Bio-Horizons. Both of them very popular in the USA.

Question 4:  Along these same lines, what types of crown materials does your clinic tend to use in  which particular situations (e.g., front teeth, molars, etc)?

Answer: Regarding crown material selection, this is very specific for every case. When

selecting the material we need to take multiple aspects into consideration and

select the material accordingly. I like to use a lot e-max crowns from Ivoclaar.

They offer great strength and aesthetics. In cases where we have very limited

space and we require a stronger material, we might consider Zirconia or

porcelain fused to metal. I sometimes combine, using a more aesthetic material in

the front teeth like e-max and a stronger material for the back teeth like

porcelain fused to metal. It depends in the clinical situation, the important thing

here, is to have adequate knowledge of how to pick your material correctly in

order to have good longevity with your crowns. The biggest mistake I see, is

some dentists don’t know their materials and rely on their lab-technicians for

advice, trust me, understanding what materials to use is a critical component of

success.

Question 5:  Your clinic web site is in English to attract patients from the US, in addition to all your local clientele.  What are the most common concerns of your US patients, and how does your clinic try to address them?

Answer: In relation with international patients, we have been blessed to have great

patients and make a special friendship with lots of great people. Our website

provides some information and we are putting up a new one this week.

International patients always have concerns and are sometimes a little scared to

travel to a different country to get dental care.

When a patient contacts our office, I always take the first phone call, I spend as

much time as the patient needs to answer questions and make them feel secure.

We provide our patients all the necessary information and follow up before,

during and after their treatment. We explain every single detail, procedures,

pricing, lodging and all aspects before they come to Costa Rica. Once the patient

feels comfortable, everything becomes smooth.

We provide our patients a boutique type service, I usually only see one patient a

day when there is a big case. I talk with my patient and provide them special

individual care. We don’t do assembly line type dentistry (this happens a lot) we

serve each patient with quality. This helps them a lot and calms them down, after

all they are looking for a positive experience and good results.

We have a lot of pride in our dental work, we don’t compromise our quality and

patients can feel that. They like to see we have our own dental lab and do

everything custom for them, all these details add up to eliminate the fears and

concerns.

Thanks a lot David!!!!

Dr. Mariano Kriebel D.D.S,Ms

And thank you, Dr. Kriebel!

Tags: DrKriebel → Implants

Interview with Dr. Mariano Kriebel of Kriebel Dental

By CometGlare → Sunday, May 8, 2016

Kriebel Dental-New report from US patient

Patient Report on Kriebel Dental

 Picked the wrong dentist in CR?  You're not necessarily doomed if you cut your losses in time and re-orient yourself.  Here's an example from a US dental patient who did just that.

She emailed me directly to discuss her adventures (or misadventures, rather).  But it all has a happy ending!

(She's given me permission to post her private email to me.  I've also posted her long review of Topix, a shorter version of which she posted #7662 earlier today on Topix.)

Thanks!  She found Dr. Kriebel on my blog (The Dentists==>Dave's Faves: The Specialists). It makes me feel good that my blog has rescued someone from a bad dental experience.

--------------------------------------------------------------------


Hi Dave,

I thought I would send you off a note, because, although I did not find your website early enough to avoid my initial dental catastrophe, I did find it in time to make a determination about which dentist to follow up with once I had to find someone to fix some problems.  Just an FYI-I was referred to your website by [name redacted by request]. I had a terrible dental experience.  I was not able to get in to Nova quickly enough given the severity of my situation, and my limited time in San Jose, but someone had recommended Kriebel Dental, and your review of them sealed the deal for me.  I am just dropping this note because I wrote a review of my experience and want you to know that you are not steering people wrongly to see Dr. Mariano Kriebel or his dad Dr. Ricardo Kriebel (or any other staff members at Kriebel Dental), for reasonably priced, top of the line dental work. 

I would be happy to answer any other questions you have…but just wanted to say thanks for spending the time and effort putting together such an intelligent and informed website (not driven by profit)…it really helped me.  

Again, thanks for hard work that really benefits people,

Best regards,

XXX XXXX,

Here is what happened to me-and how I wound up at Kriebel Dental: 

Without a doubt, Kriebel Dental is the BEST dental facility I have EVER been to ANYWHERE that I have lived, including six states in the US, Japan, The Netherlands and Mexico. 

Across the board, I have never encountered such a stellar combination of attributes in one dentist: Scholar-level education and training, polished, adept and PAINLESS clinical skills, experience borne from a 100-year lineage of dentists, and unparalleled, patient-centered treatment ethics.  Bar none, Kriebel Dental is in a league of their own.   The fact that I left Costa Rica raving about my dental experience says quite a bit about the provider.  This is especially true given the severity and complexity of dental problems I had developed by the time I finally (and fortunately) found my way to Kriebel Dental.  It’s difficult to articulate just how grateful I am that I wound up under the care of Dr. Mariano Kriebel, because I know the outcome would have been different had I not been directed to someone with his skills and experience.  The work that I required took a level of assessment and planning that most dentists are not trained for, and among those that are, few, if any, will actually invest the time to do the work correctly.  It simply does not maximize the profit margin, and, from what I have seen and experienced, many dental tourism clinics are focused on one thing: profit.  But, that was not my experience at Kriebel Dental at all. In fact, it was just the opposite: the treatment I received was patient centered and compassionate.  And, the final goal was excellence in dentistry-so my story ends well.  

 However, my dental tourism story did not begin well. While still in the US I had chosen a dental clinic based on poor criteria, and when I arrived to have the work done, it was a hellish experience and ended with me having work done that I was unsure of.  This was because I felt pressured and uncomfortable, and was so tired from flying overnight that I was not thinking clearly.  Thus, I allowed myself to be talked into something that I really should have taken time to think about.  By the time I got to Dr. Kriebel, my poor dental health was further complicated by questionable procedures, all adding to an already complex case.    

As background, I had decided to make the trip to San Jose because the condition of my teeth had deteriorated severely from patch-working dental problems for too long. The financial cost of the ‘quick fixes’ I had over the years had far exceeded a full mouth reconstruction, and without any of the benefit.  I have a severe grinding problem (Bruxism) and was at the point where my bite was so far off that I had worn through bonding, veneers and crowns, and was rapidly losing teeth.   

 For years, I had been hearing that Costa Rica was “The Dental Tourism Destination”  (even my US dentist admitted to this), so, once I made the decision to go, I decided to do my own research, believing that my experience as a “researcher” would ensure that I found a dentist qualified to deal with a situation as complex as mine.   This was a bad decision, in that not all dentists who appear to be “qualified” on the internet are equal.  So, although I followed very specific criteria in my search (eg. those listed with the US Embassy, mentioned on dental tourism referral sites, memberships in professional organizations, etc), in the end, I wound up choosing the Clinic whose name came up most frequently in my search.  I now understand that this simply means that they pay for more advertising than others, and says nothing about the dentists’ qualifications, or the quality of their work.  

 The good news is that I WAS directed to Kriebel Dental and I am inordinately grateful.  Everything about the experience can be rated as outstanding.  Upon entering the clinic I noticed that the office reception is immaculately clean, tastefully decorated, quiet and peaceful, and it is staffed with gracious, welcoming people. I immediately felt comfortable and experienced a huge sense of relief.  The rest of the clinic was equally pristine-every room that I saw was spotless, organized and clearly sanitary.  The dental chairs face huge glass windows with a view of Sabana Park, with mountains as backdrop. Thus, the environment itself is recipe for relaxation.   When Dr. Kriebel came in, I explained my situation to him, chatting on, probably way longer than I should have.  He sat and listened calmly, and (I felt) non-judgmentally, as I babbled on about my deplorable condition and horrendous experience.  There was something about his demeanor that just calmed me down.  He took x-rays, did an exam and asked a number of sensible questions that no-one had ever asked me before.  It was clear that he was listening with a high attention to detail.  At the end, he explained that I did have a complicated situation but it certainly was manageable, and in fact, it was his specialization.  It was at this point that I learned that he had done a four-year specialization at Ohio State University-and this was above and beyond his DDS.  Being an academic myself, I know that Ohio is an excellent school and getting in as an international student is no easy feat.   I asked if he could start immediately, thinking he would jump at the chance given the amount of work that was going to be involved.  He said no.  He wanted to spend time reviewing the x-rays and considering options, and then he would draw up a plan and go over it with me.  I was disappointed because I wanted it all fixed immediately, but internally, I knew I was in the right hands.   

In the end, I had two dental implants and some temporary crowns on the uppers, and all of my lower teeth crowned. Dr. Sergio Ortiz performed the implant surgery and was equally professional.  The procedure was seamless and they took care to ensure I understood every aspect of what was happening.   I am absolutely thrilled with the outcome and will be going back to finish the uppers in the Spring.   Everyone I have shown agrees that my new crowns are beautiful and very natural looking.   

 But, in addition to the appearance of the final product, the process itself was extraordinary, and is testimony to the fact that Dr. Kriebel is a consummate professional.  He is a very rare combination of new-school dentistry and old-school work/professional ethics.  He spent an inordinate amount of time attending to details, including consideration of any possible factor that could affect my bite, and then working to perfect each factor.  Meanwhile, he would regularly check in with me to be sure I wasn’t feeling any pain.  At some point I found out that he was using children’s anesthesia on me and that was why he was asking about pain so frequently.  When I asked why not use regular anesthesia, he explained that he remembered me mentioning high blood pressure when he took my medical history, and apparently regular anesthesia can complicate that.   All of this equated to him spending more of his time-a place where other dentists cut corners in the name of money.   In summary, every single aspect about my experience with Kriebel Dental was excellent.  I recommend them to everyone-family, friends, colleagues, etc.  At a time where the state of medicine in the US is questionable, this was a breath of fresh air and really has renewed my faith that there are health care professionals who take pride in their work, and truly care about their patients. For these professionals patient well-being IS THE BOTTOM LINE.   

 XXX XXXX, February 2016, New York, U.S.A.

Note added 5/8/2016:  I just put up a new post with an email interview with Dr. Mariano Kriebel. (Click on the "Dr.Kriebel" label to find it.) It gives some more background on this clinic. 

Tags: DrKriebel

Kriebel Dental-New report from US patient

By CometGlare → Sunday, March 6, 2016

Update: 1/2016 Loose crown, recemented without problem

I promised to update this blog when my dental condition changed, even in a minor way, so here's my latest adventure in dentistry.

A first molar came unstuck during vigorous flossing right before New Year's.  These things always seem to happen on major holidays.  The following week, my local dentist removed it with a special tool; apparently some of the glue still held the crown firmly in place.   He examined the crown and the prep (tooth stub) and said both were fine.  He recemented it, and the dental assistant had a time removing the stray cement.  The dentist said that the molar had a short prep, but my teeth were short to begin with.

Since the crown was never loose even after it got unstuck, I'm not too worried about it now.  I've changed my flossing habits so now I floss with only one strand of floss rather than the two strands together I had been using.  End of adventure.  Will update as needed.

Happy 2016 to you, dear reader!

Tags: DrPrada

Update: 1/2016 Loose crown, recemented without problem

By CometGlare → Sunday, January 17, 2016

Typical Schedule of Holidays in Costa Rica

Here's a list of holidays in 2016 when one dental clinic in Costa Rica is closed.  I thought it would be of interest when scheduling visits. It's obvious that ticos observe different holidays than us norteamericanos.  In particular, it seems that they observe only a single day for Christmas, but take a whole week off for Easter.

Be sure to contact your own dentist: His holiday schedule might well be different than the one below.

List of Observed Holidays in 2016

·         March 21st to 25th (Holy week)
·         April 11^th
·         May 1^st
·         July 25^th
·         August 2^nd
·         August 15^th
·         September 15^th
·         October 12^th
·         December 25^th
·         2017:  January 1^st

Tags:

Typical Schedule of Holidays in Costa Rica

By CometGlare → Monday, January 4, 2016

My dental work at 4+ years (20 September 2015)

Just an update about my dental work after about 4 years and 4 months.

Things are going well, which I'm grateful for.  The dental hygenist says I have the cleanest gums of any of her patients, probably due to clean living...and seeing her four times a year.  I also love my Sonicare toothbrush (the model with the selectable settings so I can brush on "sensitive"), which I use twice a day.  And, oh yeah, I also sip bottled water all the time and swish it around in my mouth.  I'm not going to complain about success.

I also saw a local periodontist for complete periapical x-rays and to see how the work is holding up.   I was concerned about my upper right teeth which have a long history of feeling funny, but there are sinus issues too.  He said the teeth and gums were fine.  My upper left lateral incisor still feels unnaturally numb after the root canal; but there is no pain.  He said that the root looked fine, echoing what my Costa Rica dentists had told me a couple months back.

The periodontist found two small issues with how the crowns fit the gums. As he didn't notice these four years ago when he first examined me, these must reflect changes in my gum tissue since then.  The defects are quite small now, and my general dentist never even mentioned them.  However, if they continue to get worse, the time may come many years from now when I might need a couple of new crowns. There is also a small (1 mm) recession in my gum on the back side of my upper front teeth.  This actually seems much less of a problem than it did when my general dentist commented on it a year ago.  Specialists are excellent in finding irregularities.

So, my 28 crowned teeth are no longer perfect. Oh, well. But I still have 23 or 24 crowns and gums that are as good now as they were in April 2011.

I'll continue to provide updates.

Tags: DrPrada

My dental work at 4+ years (20 September 2015)

By CometGlare → Saturday, September 19, 2015

False alarm! (19 June 2015)

I have dental x-rays taken once a year, typically in the summer, and last week was the chosen week.  My usual local dentist did the honors.  After an uneventful teeth cleaning and exam ("Wow, those are great margins," he semi-whispered to no one in particular), he looked at the x-rays.  His hygienist pointed him to my #10 tooth, which is the upper lateral incisor that I had so much trouble with in 2013.  (It couldn't hold a crown, so DDS's Dr. Carranza did a root canal and Dr. Prada inserted a metal post. I've already written about how I'm not thrilled with the general idea of root canals.)

Anyway, the dentist and hygienist were in agreement:  The tooth was fractured.  I was pretty distressed, because it had been only two years since the root canal, and because I've been extremely busy lately and didn't want to spend time or money on dental stuff.  As much as I've enjoyed reading about OTHER people's experiences with implants, I wouldn't feel deprived in the slightest at not having one.

Nevertheless, I bit the bullet and sent a semi-frantic email off to Dr. P.  He responded fairly promptly, and asked to see the x-ray.  I was chagrined to admit that I didn't have anything to send him; my local dentist still uses his 30-year-old machine from deep in the pre-digital era.  Dr. Gonzalez (who rarely attends to email) also chimed in and stressed that fractured roots could impair implants because when the body tries to seal off the infection, the underlying bone shrinks.  That makes the implant precarious. Was there pain or swelling?, they wanted to know.  No, just a telltale x-ray.

More worried than ever, I promised to find a dentist with a digital x-ray machine as soon as possible.  Of course, this happened on a Thursday afternoon, which is basically Friday for dentists here in North Carolina since they usually take Fridays off.  After a worrisome weekend, I located a dentist willing to take a pic.  It was taken Tuesday morning (for $44).  An hour later it was on its way to Costa Rica on wings of electrons.  Dr. Prada, Dr. Carranza and Dr. Gonzalez all looked at it and said it looked fine: no sign of fracture or bone shrinkage or anything else.

Whew! What a relief.

I talked with the dentist's office about why they thought it was fractured, since I was curious to know.  Apparently the old x-ray equipment doesn't have the resolution of the new digital ones, and movement might affect how it looks, and...okay.  Not sure what to make of all this, but I now realize that I need to find a local dentist with up-to-date equipment to monitor my teeth.  Once again, I've learned to not take anything for granted regarding dentists.

So that's it.  I thought I'd update you on my latest faux dental adventure.  Now I have to get back to work.

-dave

Tags: DrPrada

False alarm! (19 June 2015)

By CometGlare → Friday, June 19, 2015

2015 May Updates!

2015 May Updates!

Well, it's that time of year again... Time for the May Updates on the Topix forum.

This will be the second annual May Updates. Last year was the inauguration of this tradition.  I had this idea back in late 2013, when the Topix forum was going through one of its periods.  There were a lot of off-topic posts back then and some back-and-forth arguments going on.  My idea was to have a lot of dentist reviews posted at one time in the year, allowing interested newbiews to just read a few days or weeks of posts to get the general flavor of things.  Furthermore, I thought it would be an interesting idea to have folks look back on dental work that had been completed months or years earlier and tell us what they thought.  Most dental patients give their dentists glowing reviews immediately after the work is completed, but problems usually don't become apparent for weeks or months.  So that was the idea behind the May Update tradition.

For the May 2014 Jamboree Update, I emailed dozens of old posters and tried to convince them to post.  Many did, but many ignored me.  This year I emailed just three people (who all ignored me).  So the eight people or so who have posted so far have done so spontaneously, for which I am grateful!

Some thoughts about the posts this year...

>>> I posted an update on my dental work from Dr. Prada.  It was a belated admission that I don't like root canals, which is what I always thought.  I'm still happy with the work, but I wish I had a time-machine so I could have had it all done by Dr. Prada back in 1995 when the first set of 28 crowns were placed.  He fixed a lot of the problems stemming from the 1995 crowns when he worked on me in 2010/2011.  But it is just so much easier (and less expensive) to have dental work done right the first time.

>>> I see a sour note regarding Dr. Castro by one of the posters.  I appreciate honest posts like this.  (And in my opinion, asking folks to contact him privately is the best way to handle cases like this.)  I posted a reminder to him to "Register" so that folks would be able to Private Message him if they wanted to follow up.  I remember seeing another post from a patient of Dr. Castro's (maybe by the same poster, I don't remember) in last year's May Updates (sometime in May 2014, obviously).

>>> I don't understand Infoseek's comment (#6996).  Is this directed to me or to someone else?   I don't know.  It's very easy in a public forum to write a post that seems perfectly clear to the original poster, but leaves some readers scratching their heads.  I've written many such posts.  This is another reason why I recommend that people with complaints reserve their hardest-hitting shots for private discussions, where the criticism is less likely to be misunderstood.

>>> As usual, my posts get flagged.  There are one or two guys who hold a grudge against me and flag my posts routinely.  Eventually, they will get bored and go away.  But until they do, the ratings no longer make any sense because of people like that.

Enjoy!

Tags: DrPrada

2015 May Updates!

By CometGlare → Saturday, May 9, 2015

My Interview on Alex Wideman's Implant Site

A

lex Wideman runs a web site for people needing implants.  He gives general information about implants and crowns, and advises prospective patients about their options in choosing a dentist.  I've looked at the site, and it seems to fill an unmet need.  Implants are a huge expense for patients, and it's good to see a site that tries to provide unbiased information about them.  I'm always leery that dental-oriented web sites might have some hidden agenda, so I scrutinized the site looking for any telltale signs that Alex has "sold out" to some commercial interest. I'm glad to report that I didn't find any.  Whew!

He sent me a list of questions, which I dutifully answered and sent back.  My answers are now posted as an "Interview" in the "Costa Rica" section of the "Dental Tourism" page.  If you've read the other posts on this blog, I don't think you'd find many surprises in my interview.  I provided my standard list of encouragements and warnings.  You can read the full interview here.

Why did I give advice about implants even though I don't actually have any implants?  Well, I have procedures just as complicated as implants.  Furthermore, I know folks with implants--some of whom used dentists I recommended.  Even if I couldn't tell you the technical details of their work, things turned out well, so I felt both vindicated and gratified.  So when Alex knocked, I answered.

Buena suerte and pura vida!

Tags: Implants

My Interview on Alex Wideman's Implant Site

By CometGlare → Sunday, March 8, 2015

Before-and-After Pics from Stephen: Full bridges, 8 + 6 implants (Dr. Prada and Dr. Gonzalez)

Stephen's Before-and-After photos

Readers of the Topix forum last year were treated to a round of reports from one of our intrepid dental tourists. "EssKay", otherwise known as Stephen, had a full-mouth reconstruction done at DDS Dental with Dr. Prada and Dr. Gonzalez.  He sent me his photos so everyone could see them, as he doesn't have a blog of his own.  Glad to oblige, Stephen.  I read a lot of his posts on Topix and even corresponded with him, but it was only when I saw his photos that I understood his situation.

Here are his "Before" and "After" photos:

Before: Face

Before: Smile

After: Smile

Stephen had his work done at DDS Dental by Dr. Prada and Dr. Gonzalez.  It was completed in December 2014.  He had 8 implants on the top and 6 implants on the bottom.  The bridge material is Prettau "full-contour" zirconia from Lorenzo Favini's dental lab.  These are solid zirconia bridges, without a porcelain facing.  (I think that this might be a slightly improved version of the Prettau in my crowns from 2011.)  Lorenzo likes to make his crowns and bridges as life-like as possible.  If you look closely, you'll notice that the color is a shade darker near the gum line, and that the individual "teeth" have ever-so-slightly wavy edges.  These artistic effects are a hallmark of his lab.  See the "gums"?  Those are actually part of the bridges, painted as gums.

It was quite an event for Stephen. As I remember, he had a rough time recovering from all the procedures.  But he got a great smile out of it!

He sent me a more detailed description of his work:

My arrival at DDS was predicated upon faith.  After reading all the posts on the forum, I started focusing on Dr. Prada.  This was mainly the result of reading what you and Rod [of thedentaltourist.com fame] had to say.  So when I had my first appointment in Costa Rica, I was really at the mercy of the gods and the fates.

It was determined that all my teeth had to go.  Thankfully, I'd mentally prepared myself for that eventuality for a couple of years prior to making the decision.  I knew the front teeth were a lost cause, but I thought that some of the molars were salvageable.  The truth is, even they were loose (though not all of them obviously so).  It was easier to start from scratch.

My procedures were as follows:

First trip:

• Full extraction of all remaining teeth
• Bone grafts in all implant sockets and a sinus lift
• Eight implants placed in upper, and six implants in lower
• Fixed dentures

Second trip:

• Removal of dentures and measurements taken for finals
• Because of receding gums, it was determined that full bridges were the best option.  The alternative of several bridges would have left me with an unsightly gum line when smiling.  This was compensated for by having full bridges with the "gums" a part of the bridges (i.e. all the same material, Prettau Zirconia, but the "gums" painted and baked in.
• The construction of temporary "blueprint" molds to determine shape and bite
• The final bridges permanently attached

That was pretty much it.  Of course, I went through quite a bit of mental turmoil during these procedures, but that's too subjective to be of any use to others.  The mental oscillations of each individual tend to color true perceptions.

By the way, should anyone wish to contact Stephen directly, the best way is to send him a Private Message through the Topix forum. For example, see post #6649 on the long thread. Click on the envelope icon in the left pane to send him a PM.

The patient and the dental staff say goodbye in this parting shot:

Mission Accomplished! 
Stephen's the one in the white T-shirt, flashing his final bridges.  
Next to Stephen is Dr. Prada, and on the far left is Dannia, his long-time dental assistant.

Stephen says, "I think the photo shows the respect and love I felt for all those at DDS. I wasn't the easiest of clients, but Dr. Prada was/is a gentleman and a consummate professional."

Thanks for the photos and the report, EssKay.

Tags: DrPrada → Implants

Before-and-After Pics from Stephen: Full bridges, 8 + 6 implants (Dr. Prada and Dr. Gonzalez)

By CometGlare → Tuesday, February 24, 2015

"Who's the best dentist in C.R. for VENEERS?"

Someone on the Topix forum recently asked, Who is good with veneers?  This is not the first time this question has come up, but it's the first time it's come up when I had my own blog to give my take on it. 

Veneers aren't a secret occult science, nor are they a specialty area in itself.  There are several specialty areas of dentistry, but "Veneerology" isn't one of them.  Rather, veneers are a part of prosthodontics, the specialty that covers crowns and bridges.  A dentist who is very skilled and successful with crowns, bridges, etc, should also be able to do good veneers.

Not being a dentist nor even having any veneers myself, let me just do some blue-sky thinking.  It seems to me that placing a veneer requires the same skills dentists use to place crowns, only more so:  An aesthetic sense to judge the color and select the material what would best work in a given situation; a feel for the strength of materials and cements to judge whether a given veneer would hold; technical laboratory skills to fabricate such veneers to such precise tolerances; and manual dexterity to prep the surface correctly.  In other words, it's just like setting crowns, only more difficult. At least in the judgment of this layman.

I think that this question arises from some bad experiences some patients have had with veneers.  Veneers are very likely more difficult to successfully acheive than crowns.  I suspect that some dentists whose skills are adequate to place crowns simply lack the additional skill and judgement required to do veneers. Hence this concern.

If you need veneers--or any other type of "cosmetic" dentistry, for that matter--you should choose a highly skilled dentist, rather than the first one that pops up on your Google or Yahoo search.  There are some very good dentists on this blog.  My first impulse would be to check out some of the specialists in prosthodontics.  These dentists have studied advanced cosmetic procedures under a master in their graduate programs.  Some of the other general dentists might well have acquired the experience and skills required for these procedures, but I can't speak to that.

Two years ago I talked with someone who wanted dental work done in Costa Rica for purely cosmetic purposes. There wasn't anything wrong with his teeth, he just wanted to look better.  Nothing wrong with that.  The trouble was the clinic he had chosen--a clinic so mediocre that it had trouble just doing the basics.  Like crowns.  A clinic that can't even do basic dentistry reliably cannot be expected to succeed in something much more challenging. After a long conversation, I was able to talk him out of his plan.  For this good deed alone, I fully expect to have secured my spot in Heaven.

If you want dental procedures for purely "cosmetic" purposes, you need to find someone who has excellent judgment and integrity in weighing the "downside" of the procedures you're considering, as well as having the skills to successfully accomplish it.  You want someone who can preserve what's working for you and just make it look better, not someone who will give you new dental problems.

Good luck hunting!

Tags:

"Who's the best dentist in C.R. for VENEERS?"

By CometGlare → Friday, January 23, 2015

Conversation with would-be patient

I had a long phone conversation with a would-be dental patient recently who was on the verge of a visit to C.R. to check out dentists.  A couple of isues came up that might be of general interest.

Cost was an issue for her as it is for many of us. After all, that's one reason why we're looking at Costa Rica.  For price-conscious patients, I always mention Cavallinis and Costa Rica Dental Team.  Both clinics do both full-mouth restorations and implants, but I think that the Cavallinis are particularly good to look at for economy-priced implants, and CRDT for crowns.

Another issue was scheduling procedures for implants with Dr. Gonzales.  She tried to contact Dr. Gonzales first and I guess that sort of surprised me until I thought about it.  Dr. G. is the implantologist (and periodontist) for Dr. Prada of DDS Dental, and so it would be natural for many US patients to make the contact with him since he would be doing the implants.  I think this may be how it works at some C.R. clinics (Dr. Anglada and Dr. Castro-maybe?), but the best and easiest procedure here would be to let Dr. Prada handle everything.  Let him be the point of contact, and if he thinks you should contact Dr. G directly he'll tell you.  This is the how both R.J. and I handled our procedures with Dr. G., implants in RJ's case and crown lengthenings in mine.  The beauty of this arrangement is that if something ever goes wrong, you just contact Dr. P., and he'll figure out how to fix it. I love that Dr. P and G work so well as a team. 

All the dentists mentioned here have their own entries on this blog under "The Dentists".
 
Pura vida!

Tags: CRDentalTeam → DrCavallini → DrPrada

Conversation with would-be patient

By CometGlare →

Readers' discussion forum

T

his page is for miscellaneous readers' comments.  If you have a comment on a particular dentist, please post it on that dentist's page.  If it's a general comment, you can post it here.

Please observe blog guidelines for posting. Be polite and respectful when talking of other folks' dentists.

Thanks!

Tags:

Readers' discussion forum

By CometGlare → Thursday, October 9, 2014

TripAdvisor threads on C.R. dentists

T

here are several active threads on TripAdvisor about Costa Rica dentists.

I like TripAdvisor because moderators remove posts that are irrelevant or self-promoting.

Here is the single longest TA thread, another long conversation here, and yet at third long one (now closed for comments).
 
And there are shorter conversations: here, here, here, here (mostly about Costa Rica Dental Team), here, here (about NOVA).  You get the idea.

To see all the conservations about C.R. dentists, you need to page through the lists of individual conservations in the "San Jose (C.R.) Travel Forum".  I've listed the significant ones that were "active" from January 1, 2014 to Oct 9, 2014, when I composed this post.

 Go

 To

Searching TripAdvisor and other parts of the Internet:
Press Here.

Tags: ResearchHints

TripAdvisor threads on C.R. dentists

By CometGlare →

What I know about implants in Costa Rica

I'm not a dentist. I don't have any implants. I have never researched implants and I really shouldn't be commenting on implants.  But I can't help myself, so I'm going to go ahead and tell you what I do know about getting implants in Costa Rica.

Implants are a mysterious topic for many US patients who suddenly learn from their dentist that they need one (or several).  Let's see if we can demystify it some.

First, as I explain elsewhere on this blog, I have nothing against US dentists.  If you have a local dentist that's an expert in implants, by all means, take advantage of him. Not all US patients are so fortunate, and so there has always been a demand for dental services abroad.

Implants are not an exotic specialty in Costa Rica.  CR dentists have been doing them for over 20 years.  Implants are now a bread-and-butter service at many CR dental clinics.  Services can range from a single implant to replace a diseased tooth, to several implants and associated crowns/bridges/appliances to replace all the teeth on the top or bottom of the mouth. I won't presume to give you any advice for your particular needs; that's the job of highly trained dentists.

You won't save much money going to Costa Rica if you just need a couple of implants: The travel costs will eat up the savings, especially since patients generally require multiple trips.  But if you need a whole bunch of implants, the savings can add up fast.  More importantly, you might be able to afford a much better dental solution in Costa Rica for the same price you would pay in the US for a lesser solution.

All of the clinics listed in the "The Dentists" menu do implants.  Patients frequently post on the Topix and TripAdvisor forums about their experiences in Costa Rica with implants.  In the last year alone, people have posted on Topix from these clinics: Cavallini clinic, Nova (Dr. Obando), DDS (Dr. Prada and Dr. Gonzales), Dr. Anglada and others.  My knowledge about implants comes from these posts, and occasional conversations with other patients.

The Cavallini clinic offers high-quality, economically priced implants.  They have placed over 21,000 implants since 1980.  There is discussion on the Internet boards from time to time about the best types and makes of implants, but I don't follow those discussions.  Sorry!  Most patients don't care about the particulars as long the final result is solid and aesthetic.

The Costa Rica Dental Team also does implants; please see their page.

This photo of a lone surfer at the edge of the Costa Rican surf is so relaxing to me.  I hope it relaxes you too.  And if you're reading this blog to research dental implants abroad, you could probably use a little relaxation!  (123RF stock photo)

The specialist clinics discussed on this blog (DDS, Nova, Anglada, and other specialty clinics) offer specialist services, naturally:  One specialist places the implant and another specialist fits the crowns/bridges/appliance.  The dentist placing the implant is sometimes called an implantologist.  Though a graduate of a US specialty program would more frequently be called a periodontist with training in implants.  Implantology is not a separate specialty in US dental schools, though it is in other countries. The dentist placing the crowns would be called a prosthodontist (if he holds a graduate degree in that specialty).  Prices for implants by specialty clinics are pretty standard, about 800 or 850 for just the implant (no crown) according to one person I talked with recently (Oct 2014).  Prices for a crown-on-implant run a little higher than crown-on-natural teeth.  As there are different choices of crown material with different prices, it's hard to quote a figure.

If I needed an implant today, I would probably use my current dentist with a high-end crown made by a top outside dental lab. (I would go to Costa Rica even if I needed only one implant.)  I think that this would run a little above $1800, implant plus crown.  This is the route that one patient took last year for his rather involved case.  It worked out well, judging from Rod's blog, which has already inspired several people to make the pilgrimage to Costa Rica.

For exact prices, you will have to contact the clinics directly.  You can find the URLs of their web sites listed on the clinics' individual pages in the "The Dentists" menu of this blog.  To get comparable quotes, please be specific in the work you need done and how you will pay (credit card or cash/wire transfer).  Some dentists include extractions in quotes, others charge separately.  Most dentists quote credit prices, but some quote cash prices, which are generally lower.   You can also explore choices in crown or implant materials.

Some dentists will work up a prospective treatment plan for complicated cases based on x-rays and photos you send them.  The treatment plan will show how the dentist proposes to treat your case.  It might offer alternative approaches.  See my Q and A posts for more information.

Of course, implants are performed by clinics not discussed on this blog.  Feel free to explore your options among good Costa Rica dentists. It's always great to learn about great, new dentists.

So that's it, folks.  That's all I know about implants.  It's not a lot, but it should be enough to give you a few ideas and get you started. And that's as much as this blog aspires to do.

Pura vida!

Tags: DrAnglada → DrCavallini → DrPrada → Implants → Obando

What I know about implants in Costa Rica

By CometGlare → Sunday, October 5, 2014

Guidelines for Comments

Pacific sunset at Matapalo, Costa Rica

R

eaders:

Your comments are welcome.

If you had an experience with any of the clinics listed as Favorites on this blog, either Dave's Faves or Internet Faves, your comments are appreciated.  Even if your experience was a bad one, please let me know.  I can't promise that I'll post your reply, but if I see a pattern of unhappy patients, I'll remove that dentist from my Fave lists.

If you had a good experience with a dentist not list as a Fave, please comment on the "Readers Share Their Favorite Dentists" page. If you have a miscellaneous comment not pertaining to a particular dentist, you can comment on the "Readers, Sound-Off Here!" page.

Many readers will want to know:

• What was the name of the dentist(s)?
• When did you have your work?
• What work did you have done?
• Anything about the experience that's particularly memorable?

Some optional questions:

• Was it painful?
• How did the dentist handle any post-treatment issues that came up?
• Can you comment on the quality of the workmanship?
• What did it cost (if you're comfortable providing that)?
• Suggestions on travel arrangements or accommodations?
• Has another dentist examined the work?  If so, what did he think?
• If you have a personal blog, you may post its URL.
• 
  You can help readers find you on Topix or TripAdvisor
  by providing the post number and the URL. Please don't recopy your post, just post a note like this:  "For more on my good experience with Dr. XXXX, please see my post #6383 on http://www.topix.com/forum/world/costa-rica/THGCO47LHH1FS7DR7/p307."
  We need the URL because there are many separate threads on TripAdvisor and two separate threads on Topix with almost 400 pages.  Give us the post number too.  Topix posts sometimes change pages as the thread ages.
• 
  If you want folks to be able to contact you, please put your email or web site URL in the post, or refer readers to a post on Topix or TripAdvisor where they can send you a private message.

Finally, help me maintain a respectful and upbeat tone on this blog.  Please don't post comments that are: Disrespectful, unfounded in fact, or phrased overly harshly against any dentist.  There are more appropriate outlets for those kind of posts.

If this is the first comment you've posted on my blog or another Blogspot blog, you might want to make a copy of your comment before posting it. Blogspot may ask you to sign up the first time you try to post, and your comment might get lost in the confusion.

Tags:

Guidelines for Comments

By CometGlare → Wednesday, October 1, 2014

My Preferred Dentists: One Overview and Three Apologies

Q: Which dentists do you personally recommend, and Why?

      A: I recommend several dentists.  In my mind, these dentists fall into four different groups depending on how well I know them.
    (1.) Dr. Prada and his colleagues at DDS Dental.  He's my dentist, and I know him very well.  I've sat in his chair for dozens of hours on five different trips.  I've exchanged countless emails with him, and have even ridden as a passenger in his car.  On a scale of 0 to 100, my Personal Knowledge of him is about a 90.
    (2) Specialists, even if those I haven't heard of.  I have a bias towards dentists who received graduate education *after* their DDS degree.  In the interest of full disclosure, I freely confess this bias of mine up front.  In my eyes, the training of specialists not only distinguishes them educationally--as having served an apprenticeship under excellent established specialists--but it also distinguishes them as having been selected for such training to begin with.  Graduate programs will attempt to choose only the best candidates.
          I recommend that you discover new specialists, those trained in the US (therefore, English-speaking) or those trained in other countries (often English-speaking).
           On my Personal Knowledge scale, all these specialists taken all together as a group rate only a 15 out of 100.  I know them mostly by reputation and some Internet postings. However, my belief in the implicit guaranty provided by their specialty training prompts my recommendation.
    (3) My two favorite general dental clinics of which I have personal knowledge:  The Cavallini Clinic and Costa Rica Dental Team.  I sat for an exam at both clinics in 2010, and have researched them carefully.  I have followed their progress in the years since, and have been impressed with the quality of the work done at very affordable prices.   On my Personal Knowledge scale, each of these clinics individually rates a mere 5 or 10 out of 100.
   (4)  Two clinics that appear over and over on the Internet blogs:  Nova Dental (Dr. Luis Obando and his colleagues) and Dr. Anglada.  I have researched neither dentist, but I've heard excellent things about them on TripAdvisor and Topix.  I would be remiss in not mentioning them to you as you begin your own research.  On my Personal Knowledge scale, these each of these clinics individually rates a mere 5 out of 100.   Dr. Obando and Dr. Anglada are both specialists, trained outside the US, so they fall comfortably within category (2).

Each dentist named above has a page devoted to him in this blog under "The Dentists".  There is a also separate page for specialists as a group.

Q: Do you personally guarantee I'll be happy with any of these dentists?

      A:  I have a lot of personal faith in these dentists, especially "Dave's Faves."  All of these clinics provide quality work.
          But I don't suggest choosing a dentist at random.  Quality is important, yes, but so are other things.  Some are tangible, such as price; others are intangible, such as clinic atmosphere or dentist-patient rapport.  Find a dentist who is an good "fit" for you, not merely one who is excellent in the sense of having good technical skills and access to a good dental lab.
          And if you're not happy with one of the dentists on my site, let me know.  I don't expect much dissatisfaction here--provided you choose a dentist who's not a bad fit for you to begin with. 
          And I apologize in advance if you're not happy.

Q: How about the other great dentists in Costa Rica not discussed on your blog?

      A:  I apologize in advance for not knowing about other great dentists in Costa Rica.  I always wonder about the specialists trained outside the U.S.  I think some of these could be real hidden gems, waiting to be discovered.
            I know there must be little known great dentists in CR, and I'd encourage you to seek them out and sing their praises.
           

Q: How about great dentists in the U.S.?

      A: If you have a great local dentist in the U.S., by all means, take advantage of the situation.
           I'm not trying to break the bond between Americans and their local dentists.  I'm trying to steer people away from mediocre local dentists (in the US or CR) and toward fine dentists in CR.  It's just a bonus that CR dentists are usually more affordable than their US counterparts.
           But if you somehow got the impression that I had something against US dentists, I apologize.

Tags: CRDentalTeam → DrAnglada → DrCavallini → DrPrada → Obando → Q_and_A → ResearchHints

My Preferred Dentists: One Overview and Three Apologies

By CometGlare → Monday, September 29, 2014